Within Malawi's partnership framework, developing a skilled health care work force, and implementing and scaling up national systems for collection and use of strategic information are of high priority. As the number of patients served by national HIV programs increases, the challenge of providing sustainable and integrated services also increases.

The International Training and Education Center on HIV (I-TECH) was founded in 2002 by the Health Resources and Services Administration (HRSA) in collaboration with the Centers for Disease Control and Prevention to share lessons learned from the U.S. domestic AIDS Education and Training Centers. I- TECH works primarily on activities that contribute to the achievement of PEPFAR. Working at the invitation of Ministries of Health and USG, I-TECH supports the development of comprehensive training systems for health care workers in regions hardest hit by AIDS. Ongoing mentoring activities, pre-service education, infusion of multimedia into training and distance learning are high impact teaching

methodologies utilized by I-TECH.

I-TECH has been working with CDC in Malawi since 2003 to support capacity building activities. Since 2005, I-TECH has placed Technical Advisors (TAs) at the Lighthouse Trust (LH) to: 1) support the ongoing development of healthcare worker (HCW) training systems; and 2) establish a robust monitoring and evaluation (M&E) unit to ensure it has the means to effectively evaluate its work. In 2007-08, I-TECH was invited to build capacity of the MOH to lead the national response to the HIV epidemic through placement of high level TA's within key units of the MOH. Their focus is to: 1) facilitate the continuation of antiretroviral therapy (ART) scale-up and to develop and implement treatment and care models for HIV/AIDS; and 2) to strengthen the strategic information systems of the Central Monitoring and Evaluation Division (CMED) and the HIV and AIDS Department of the MOH; 3) to strengthened the MOH's capacity to collect, manage and use strategic information. With a focus on building and reinforcing Malawian capacity, I-TECH has recruited and placed the following positions in the MOH:

• One (1) senior HIV Care and Treatment TA • Two Malawian (2) HIV Fellows • One (1) senior M&E TA • One Malawian (1) M&E Fellow • One Malawian (1) Information Technology (IT) Fellows • One (1) Global Fund Coordinator • In 2010, I-TECH will continue to support the Lighthouse through the recruitment of a TA for M&E

In 2010, I-Tech will also work directly with the Christian Health Association of Malawi (CHAM), a CDC partner, to produce 500 new healthcare workers by 2015. This initiative is in response to the critical need to mitigate the human resources crisis, particularly in the health sector. A holistic approach, including fortification of the training infrastructure, strengthening of faculty skills, and addressing gaps in retention and successful preparation of students is key to success. I-TECH's framework for training reflects the importance of a comprehensive approach to clinical training and is designed to ensure that training programs result in the transfer of learning to the jobsite. Clinical mentoring is a critical component of I- TECH's comprehensive approach to training, as it provides a bridge between didactic training and independent clinical practice. I-TECH's recognition of the importance of clinical mentoring is in alignment with global efforts to decentralize the provision of ART, expand the number of sites providing HIV treatment, and empower local experts to provide the care and leadership necessary to combat HIV.

In 2008, I-TECH opened an office in Lilongwe, and initiated the process of registering as a local NGO. To continue to support the growing number of technical and clinical staff, and the new initiatives to deliberately build local capacity, I-TECH will continue to establish its operational infrastructure and

required personnel in Lilongwe, including a country director, operations manager, and fiscal lead. Equipment such as 2 vehicles, laptops, computing supplies, and other necessary technology will be provided to its in-country staff to ensure their ability to continue their work.

In collaboration with the Country Director (TBN), the Seattle-based I-TECH Country Project Manager (CPM) will continue to foster the professional growth of the technical and clinical staff through long distance consultation and support, in-country visits, and liaising with other technical and clinical staff at HQ and within the region. The overarching goal of I-TECH is to provide technical assistance to strengthen national health systems, provide mentorship through expert technical advisors, and build capacity of Malawian healthcare workers. In order to attain our vision of a high quality, compassionate and equitable health care, in a sustainable manner, we will improve our mentoring model in a contextually appropriate manner, placing greater emphasis on the transfer of skills and leadership development to our Malawian fellows, new healthcare workers, and partners.

This program will have national level impact in Malawi, increasing access to HIV and TB services through increasing the capacity of health facilities and health workers. The quality of HIV and TB services will be improved through provision of regular supervisory visits and on-going training of new and current health workers in relevant skills and knowledge. This program will also strengthen supportive services including laboratory, expansion of electronic data systems, revision of other paper-based M&E tools, as well as infrastructure needs.

This is therefore in line with the goals and objectives of PEPFAR. The monitoring of activities in each program will be done through quarterly reports documenting progress toward objectives, lessons learned, and best practices. Reporting on activities conducted will be through existing reporting mechanisms, and will be submitted to MOH supervisors and I-TECH HQ. Progress and other requested reports will be provided as needed to HHS/CDC.

Budget Summary PFIP Year 1 Funding - $1,200,000 PFIP Year 2 Funding - $2,750,000

II. Budget Code - HTXS $300,000.00 - Year 1 $300,000.00 - Year 2

Activity 1: Human Capacity Development in antiretroviral (ART) Management and Distribution (Continuation Activity and Expansion). In 2009, the national HIV guidelines were revised and updated. I-TECH supported the efforts of the MOH in the revision of the 5-day national ART curriculum to incorporate the new changes of the revised ART guidelines 3rd Edition and revised Opportunistic Infections (OI's), guidelines. A pilot training was conducted in Blantyre and I-TECH incorporated the revisions into the final training product, including the development of slides, facilitator guides and participant handbooks.

In FY 2010, the department of HIV & AIDS will continue its work to build the capacity of 100 healthcare workers (HCW), including, clinicians, nurses, medical assistants, and clerks in ART management and ARV distribution and data collection and collation. The I-TECH Care & Treatment Technical Advisor and HIV fellows, will assist in planning and support for the ART training & mentoring program for both old & newly recruited staff and staff sent on attachment to ART sites in the public and private sector as part of their training. Within the Partnership Framework's overall goal to support the GOM's NAF, the I-TECH Technical Advisor will: • Support assessment of new sites that are intended to scale up the provision of HIV treatment services at the ART sites.

• Develop and implement effective national communication strategies for the dissemination of information and best practices to HCWs in the public and the private sector. • Contribute in the design and implementation of Training of Trainers (TOT) to conduct ART refresher course in collaboration with the District Health Officers according to their District Implementation Plans (DIP's).

Activity 2: Assist the MOH with the expansion of ART Services The responsibilities of the I-TECH Technical Assistant in Care & Treatment has been divided equally between oversight for the expansion of ART services and training, quarterly supervision, as well as mentoring the senior leadership team of the HIV Unit including the Malawian Staff Fellow counterparts. The Technical Advisor will contribute to the development of the ART scale up plan 2010-2013 which will replace the 2006-2010 scale up plan. The 2010-2013 scale up plan will be based on the extended National Action Framework (NAF) and will build on the successes and the lessons learnt from the previous plan. A main priority for 2010 will be the strengthening of drug forecasting and procurement systems and processes. The Technical Advisor will also contribute to the ART drug, OI drugs and HTC test kits quantification, costing, procurement and distribution exercise.

Activity 3: Design and implementation of national pre-ART program In collaboration with partners & stake holders, as part of the scale up plan, the Technical advisor will contribute to the design and implementation of the pre-ART program covering a continuum of care from antenatal clinic (ANC) through Early Infant Diagnosis/ presumptive severe HIV disease in children under 18 months up to adolescence and adult HIV care that will be termed Family HIV care clinics. These will encourage a family model approach to HIV care. Guidelines will be produced that define the minimum package for pre-ART at any given site nationwide.

Activity 4: Resource and on-site Support Supervision In 2009, I-TECH recruited and placed 6 technical and clinical fellows and TAs within the HIV and AIDS Department who have contributed their expertise to expand the capabilities of the HIV Unit. This team has provided critical support to all other ARV service providers through training and on-site support supervision. In 2010, they will continue their activities to oversee the collection and collation of valuable data on the expansion of ARV services and ensure the quality of the services as programs expand. The team will work with others in the HIV Unit to prepare long-term plans, annual work-plans, 6-monthly reports, and other ad hoc reports on the state of scaling up and performance of the ART support services and operations research. The Unit will ensure timely dissemination of reports and updated guidance.

PEPFAR funds through I-TECH will directly support salary and benefits of 1 care & treatment TA (90% FTE) and two HIV fellows (40% FTE), training materials, travel support to 1 international conference and

2 regional conferences, laptops, vehicle and fuel (limited to work-related travel only), and supplies.

IV. Budget Code - HVCT $50,000 - Year 1 $50,000 - Year 2

Activity 1: System Strengthening and Quality Assurance for HIV Counseling and Testing (HTC) Massive scale up of HTC services in Malawi has only been possible through a radical 'task-shifting' approach. Non-medical /non-lab health extension workers (Health Surveillance Assistants) and lay staff who have undergone a 3-6 week specialized training in HIV testing and counseling are thought to account for over 90% of HTC in Malawi. While this approach has been successful in making HTC widely available, it has been increasingly challenging to ensure adequate quality assurance (QA) and quality control (QC). To address this critical area, the national M&E TA has assisted the development of a comprehensive follow-up system for all HTC providers operating in the country. A central database will be established at MOH to register all HTC providers and assign unique IDs.

HTC provider log-books will be issued to all HTC providers (estimated 3,500 as of mid 2009) to allow tracking of individual providers, to document qualification and refresher trainings attended, and to record participation and outcomes of HIV proficiency testing results. The ID system and the provider log books will be piloted in 3 districts in 2009 and national roll-out is planned to start in 2010. The log books will be an important tool to ensure effective supervision of HTC services, to track outputs from HTC trainings and to ensure adequate quality of HIV testing.

PEPFAR funds through I-TECH will directly support salary and benefits of 1 M&E TA (10%) and one 1 M&E fellow (10%), training materials, complimentary travel support (separate from MOH-provided travel allowances), and supplies.

V. Budget Code - HVSI $200,000 - Year 1 $650,000 - Year 2

Activity 1: National Monitoring and Evaluation of HIV Services I-TECH is supporting the MOH through a senior Technical Assistant for M&E who took up his position in September 2008 and one locally recruited M&E Fellow who was appointed in January 2009. The rapid and massive expansion of HIV services in Malawi since 2002 has required establishment of new M&E systems for HTC, PMTCT, STI and ART. It has been a particular challenge to ensure that these M&E systems can satisfy the complex technical requirements for longitudinal patient monitoring while needing to keep pace with the rapid scale up. M&E tools developed during the first phase of scale-up had critical data gaps and were often not well integrated into the general Health Management Information System (HMIS), which has the overall mandate for monitoring of the SWAp (Health Sector Wide Approach) and Program of Work within MOH.

As HIV services are becoming more established in the general health services, there is a need for the Department for HIV and AIDS to consolidate and rationalize M&E systems and work towards a full integration into the HMIS. At this critical juncture, a high level of technical expertise is required to design adequate and sustainable tools and oversee the deployment of the appropriate IT systems. The new M&E Unit within the HIV Department is responsible for monitoring site and program performance, disseminating information relevant to policy development, quantification and forecasting of drug and commodity needs, and for directing operational research.

I-TECH is prepared to provide the necessary support, professional development opportunities, and IT- related operations and infrastructure for routine data collection. Resources will be offered including networking, database development, long-distance consultation, and other necessary resources such as computers, software, communication technologies, sponsorship of the senior Technical Advisor and his/her local counterparts at major conferences and meetings, and a vehicle for meetings and quarterly HIV services supervision. As part of I-TECH's global team of M and E Technical Advisors, the MOH M and E Advisor will have extensive tested resources to draw from in health services monitoring and quality improvement.

In year 2 of the PFIP, HVSI activities include:

Activity 1: Devise national standard system and M&E tools for integrated follow-up for HIV exposed infants and pre-ART services for children and adults 'Family HIV Care Clinics' The lack of any standardized system to ensure effective identification and follow-up of HIV exposed infants and of pre-ART interventions for children and adults has been identified as a critical gap in the national HIV response. The I-TECH technical assistants for M&E and Care and Treatment, in collaboration with the HIV fellows and with the MOH HIV program officers have started to develop a

comprehensive strategy to integrate these interventions into the maternal and child health services and into the existing HIV services. A critical component in this process will be the development of standardized M&E tools for Under Five Clinics and for dedicated Family HIV Care Clinics that will integrate pediatric and adult pre-ART services. In the course of FY 2010, the following (paper) tools will be developed / revised, piloted and implemented: routine screening of infants at U5 clinics for HIV exposure (integrate HIV exposure info into U5 / U1 registers), Family HIV Care Clinic Cards for children and adults, Family HIV Care Clinic register and reporting forms, revised Child Health Passport. These M&E tools are expected to address a critical gap in monitoring of outcomes for the PMTCT program.

Activity 2: Establishment of a central M&E database for HIV Programs integrated into the Health Management Information System As of 2009, the M&E systems for HIV programs (HTC, PMTCT, ART, STI) in Malawi are not well integrated into the general HMIS and there is no coherent system for the collection of HIV data, aggregation for reporting and for data management. Facility and district level M&E reports are typically entered using improvised spreadsheets on individual PCs, giving little control over accuracy and completeness of data and making strategic information (SI) difficult to access and utilize for staff at facilities, districts and at the central level. In FY 2010, the I-TECH M&E team at MOH will lay the foundations for a full integration of HIV program data into the District Health Information System (DHIS), while supporting CMED in the transition to a new web-based version of the DHIS. The I-TECH M&E TA will facilitate the development of a common strategy for this process. This will include establishment and maintenance of a central health facility inventory linked to a Geographic Information System (GIS). It is currently envisaged that the central DHIS server will be housed in the new offices of the Department for HIV and AIDS at CHSU, making national M&E data freely available to all stakeholders over the internet.

Activity 3: Roll-out of Point of Care Electronic Data Systems (EDS) at health facilities for ART and other HIV services. Exploration of strategies for a central data repository for storing patient level data from EDS sites. The I-TECH M&E team will assist with coordination and supervision of the roll-out of EDS for ART which is planned to start in FY 2010. Technical assistance will also be provided to the EDS implementing partners (Baobab Health Partnership and Luke International Norway) in order to ensure adequate design of software and database architecture. The team will make an important contribution to the national data standards task force and assist with the development and implementation of standards related to information systems (e.g. confidentiality and security of electronic data). The I-TECH M&E TA and the IT fellows will further facilitate the exploration of strategies for establishment of a central data repository for patient level data from EDS facilities, considering the business case for different technical solutions and ensuring that aqdequate data security measures are guaranteed to protect patient data.

Activity 4: Mentoring of fellows in development of M&E tools, data management and operational research. Recruitment and training of 2 new data clerks for the HIV Department The ability to design and implement M&E systems and to correctly manage and interpret strategic information is considered a core skill for the HIV fellows in the MOH. In FY 2010 the I-TECH M&E TA will continue to build the capacity of the fellows in this important area, focusing on M&E principles, data base design and data management and analytical methods. The fellows will be trained in using professional data base applications, applying appropriate data models, use of SQL, data transformation and statistical analysis using STATA. The fellows will complete their first set of operational research studies, the results of which are expected to directly inform a review of the choice of ART regimens for the national program in early 2010. To strengthen the capacity of the HIV Department and to ensure long term sustainability of M&E systems and for operational research, 2 data clerks will be recruited during FY 2010 (through the CoAg between CDC and MOH). These clerks will be trained in IT skills and M&E and data management principles.

Activity 5: Implement integrated M&E system for HIV and STI services Until 2009, there was no effective integration of HIV testing, prevention and appropriate referral to HIV services and there were no HIV data from STI clinics in Malawi. The I-TECH M&E TA and the M&E fellow have provided critical input into the design and implementation of an integrated STI / HIV register. From the start, this new tool was designed to be integrated into the HMIS, complementing the total number of STI cases collected at OPD with an expanded data set from dedicated STI clinics (found at all larger hospitals). Implementation has started in 2009 and 3 regional TOTs have been conducted reaching 80 staff. The new tools are expected to be fully established with national data being available from 2010.

PEPFAR funds through I-TECH will directly support salary and benefits of 1 M&E TA (80%) and one 1 M&E fellow (80%), training materials, complimentary travel support, and supplies.

VI. Budget Code - OHSS $650,000 - Year 1 $1,650,000 - Year 2

Activity 1: Fellowship Program The national response to HIV/AIDS in Malawi over the past few years has been very impressive. However, management and coordination of this very complex national HIV response, including

prevention, treatment, and care has been challenging primarily because of the very limited number of staff with the requisite skills to oversee the programs. Assistance has been sought through expatriate Technical Assistant staff to temporarily fill the human resource gap while building local capacity through skills transfer.

This capacity strengthening is also being balanced by the addition of extra manpower in key MOH departments through the Malawi HIV Fellowship Program, where 4 Fellows, and one fellow in recruitment are placed under the I-Tech supported Malawi HIV Fellowship Program. The fellowship offers opportunities for mentoring, coaching, and applied training in leadership and management to exceptional physicians and other healthcare professionals in Malawi. As the program matures, this program has the potential to become a robust model for leadership development in public health managers in Malawi. The HIV Fellowship Program is a field-based, non-degree opportunity which consists of a full-time apprenticeship attachment in the Ministry of Health. I-TECH will support the Fellows' professional development goals through distance learning courses, attendance at national and international conferences, and targeted trainings.

I-TECH budget directly supports salaries and benefits of the fellows (see above sections for percent of FTE breakdown), 1 international travel, and 2 regional trips, some in-country transportation support and professional development opportunities (e.g. STATA course, workshop in operations research, leadership development workshops, mentoring in informatics, equipment (laptops) and supplies, communications support (mobile phones and internet) etc.)

Activity 2: Technical support in human capacity development to Christian Health Association of Malawi: CHAM (PF09 Funding - $1,000,000) The human resource crisis in Malawi impacts all sectors of development but none so pronounced as the health sector. The effective diagnosis, care, and treatment of infectious diseases require a skilled and motivated workforce, and sustainable systems to educate and train those workers. I-TECH supports the development of a skilled health work force and well-organized national health delivery systems in order to provide effective prevention, care, and treatment of infectious disease in the developing world. I-TECH combines the intellectual talents of leading clinicians, educators, researchers, and instructional designers to form multidisciplinary project teams. This results in innovative, comprehensive, and targeted capacity development activities that are tailored to the needs of individual countries.

In 2010, I-TECH will directly with the Christian Health Association of Malawi (CHAM), a CDC partner, to produce 500 new healthcare workers by 2015. This initiative is in response to the critical need to mitigate the human resources crisis, particularly in the health sector. The I-TECH approach to training recognizes that classroom-based training alone is not sufficient to support the application of complex clinical skills

related to care and treatment of people with HIV and AIDS (PLWHA). A holistic approach, including fortification of the training infrastructure, strengthening of faculty skills, and addressing gaps in retention and successful preparation of students is key to success. I-TECH's framework for training reflects the importance of a comprehensive approach to clinical training and is designed to ensure that training programs result in the transfer of learning to the jobsite.

The framework outlines a model in which the trainee progresses from acquisition of new skills and knowledge in the classroom, to closely supervised clinical practice of new skills, to increasing independence and responsibility in care and treatment supported by onsite mentoring, to initiation of the provision of guidance and advice on an as-needed basis. Responsibility and decision-making are thus gradually shifted to the trainee throughout this process as the trainee acquires increased skill and confidence, and this framework supports I-TECH's efforts to build capacity in a sustainable manner and in a way that allows local experts to continue the provision of care. Clinical mentoring as a bridge between didactic training and independent clinical practice is recognized as critical and in alignment with global efforts to decentralize the provision of ART, expand the number of sites providing HIV treatment, and empower local experts to provide the care and leadership necessary to combat HIV. To this end, I- TECH will hire 2 clinical mentors, and one training coordinator/project manager to work directly with CHAM's and two of its selected training colleges, to build the skills of the faculty, increase student retention and passing rates, and support CHAM in their delivery of 500 new healthcare workers by 2015.

By partnering I-TECH and CHAM we have the greatest opportunity of launching a program that would produce 500 high quality professionals that would add to the workforce of Malawi.

Through the new partnership framework and in line with Malawi's National Action Framework, I-TECH will complement current investments in the national HRH plan by supporting CHAM to producing 500 mid- level health professionals such as nurses, clinical officers, medical assistants, pharmacy technicians, and laboratory technologists. The intent is for these professional staff to not only help fill the existing vacancies, they would also work to complement the more than 11,000 HASs recruited and deployed by the Government of Malawi.

? By January 2010, assess the quality of training services at the 5 identified CHAM training colleges for baseline information. The purpose of the assessment is to help provide a body of data on the selected colleges in order to assist CHAM determine the most effective strategy for increasing the number of health care workers trained while ensuring that a high quality education is delivered. The focus of the assessment will be primarily on nurse training. ? Write assessment report. Make recommendations and plans for strengthening 2 of the 5 training colleges.

• Identify critical gaps in training implementation and help develop strategy for strengthening the quality of training • Assist with curricula and training guidelines upgrades to include AIDS care • Identify nursing competencies and develop competency-based curricula • Assist with product and tools development (learner tools and teacher tools) and deployment • Assist with faculty development, including but not limited to: strengthening Tutor teaching skills (both within the classroom and clinical facilities for student practicum experiences), increasing/updating clinical skills, building skills in writing effective lesson plans, evaluating students' performance, mentoring and coaching. • Assist with quality assurance of training programs, and improvement of student success rate • Assist with evaluation of effectiveness of training

Activity 3: Human Capacity Development in Monitoring and Evaluation of Clinical Services at Lighthouse Trust Lighthouse Trust, a center of excellence in HIV counseling, testing, care and treatment centered at Kamuzu Central Hospital in Lilongwe, partners with the Ministry of Health to develop, test, and disseminate proven strategies for health worker training and HIV services delivery in Malawi. Since 2005, I-TECH has supported M and E activities of Lighthouse clinical services through technical assistance, human capacity development, and systems strengthening. In 2009, I-TECH will provide additional reinforcements from its Headquarters' based Quality Improvement unit to the Lighthouse to ensure continued technical assistance as needed. Meanwhile, I-TECH will recruit a clinical epidemiologist to provide systems strengthening and capacity development to Lighthouse's growing M&E team.

The technical assistance will be focused over a 2-year period with a goal toward establishing sustainable systems within the LH. The newly recruited TA will work with the M&E officer and Lighthouse director on a transition plan toward self-sustaining M&E Systems. This TA will mentor Lighthouse M and E counterparts to develop and apply appropriate monitoring and evaluation systems covering Lighthouse's core services in: HIV testing and counseling, family-centered ART services, integrated TB/HIV management, integrated PMTCT services, home based care, community PLWHA support group programs, therapeutic feeding, and clinical training programs.

PEPFAR funds through I-TECH will directly support salary, benefits, relocation benefits, laptop, telephone, 1 international and 2 national/regional travel for presentation at conferences and training, and technical support for one clinical epidemiologist/M&E specialist.

Activity 4: Strengthening coordination in the implementation of GFATM Grant Activities (Centrally Funded

- $300,000) Malawi's GFATM envelope for HIV/AIDS, TB, HSS and Malaria is currently $791,690,180 (2003 - 2013) including the recently extended HIV Round 1 Grant, through the RCC. The Malawi Global Fund Coordinating Committee (MGFCC) provides oversight for all disease grants and the HSS Round 5 Grant to the Ministry of Health (MOH). The MOH serves as the largest implementer of all GFATM resources received by the Government of Malawi (GOM). Performance has been challenged by Human Resources constraints in the MOH which have led to insufficient coordination between various directorates implementing GFATM -supported program. This gap contributes to weaknesses in the coordinated planning, critical forecasting of planning and implementation needs, and poor information dissemination between partners. Capacity is needed in the MOH for improving coordinated GFATM Grant performance. I-TECH will use its expertise in the recruitment, preparation and retention of skilled work force to support a key position who will directly report to the Principal Secretary (PS) at the MOH. The goal of this position is to strengthen coordination in the implementation of GFATM Grant activities for which the Ministry is either a Principal or a Sub Recipient, including; HIV/AIDS, Health Systems Strengthening, Tuberculosis and Malaria.

I-TECH budget will directly support the GF Coordinator's salary and benefits, transportation, in-country and 1 international travel, communications support (telephone/Internet).

Activity 5: Infrastructure support for the HIV and AIDS Department In 2009, I-TECH procured one-time equipment items and supplies to the newly renovated HIV and AIDS Department. Equipment items totaling nearly $85,000 ranged from servers to computers to software to equipment racks. In 2010, I-TECH will contract with a local agency to provide a maintenance contract to maintain and service the equipment as needed. A memorandum of understanding (MOU), which delineates the roles and responsibilities of each party has been drafted and shared with the MOH and copy has been submitted to CDC.

I. Budget Code: MTCT $50,000 - Year 1 $50,000 - Year 1

Activity 1: Training, implementation and supervision of new ANC and maternity registers and reporting forms with integrated PMTCT information

The I-TECH M&E TA has spearheaded the development of registers and reporting forms for antenatal care clinics (ANC) and labor & delivery (L&D) wards with an aim to fully integrate reproductive health and PMTCT indicators in one single set of tools. Through a consultative process involving multiple stakeholders, a revised ANC and L&D register along with reporting forms and a revised national patient- held document (woman health passport) have been finalized and these tools were printed in August 2009.

In FY 2010, over 3,500 providers around the country will be trained in the use of these revised registers and reporting forms. Implementation will be supported by the I-TECH team in the HIV Department through development of training materials, facilitation of TOTs and through follow-up supervision and mentoring at ANC and maternity sites as well as capacity building of HMIS staff at the District Health Offices. PEPFAR funds through I-TECH will directly support salary and benefits of 1 M&E TA (10%) and one 1 M&E fellow (10%), training materials, complimentary travel support (travel allowances and fuel when MOH vehicles/funds are not available or are in short supply), laptops, and supplies.

III. Budget Code - HVTB $50,000.00 - Year 1 $50,000.00 - Year 2

Activity 1: National Capacity Development: HVTB (Continued and Expansion Activity) In 2009, TB patients are being offered provider-initiated HIV Testing and Counseling (HTC) and referral for ARV services at TB facilities. Through these services, 80% of TB patients have the HIV status ascertained, and ART patients are being screened for TB at ART facilities. In 2010, emphasis will be placed on strengthening the integration of TB and HIV for co-infected clients in the ART and TB clinics. Activities will include: joint supervisions conducted with NTP and HIV of ART and TB registration sites; development of national TB/HIV integration guidelines, including WHO's 3 I's (infection control, Isoniazid, Intensified Case Findings); training of HCW in the provision of integrated HIV/TB services. The I-TECH Technical Advisor will work with Department of HIV & AIDS and National Tuberculosis program (NTP) staff to assist in integrating training strategies and appropriate tools, as they develop national TB/HIV implementing guidelines.

PEPFAR funds through I-TECH will directly support salary and benefits of 1 care & treatment TA (10%

FTE) and two HIV fellows (10% FTE), training materials, vehicle provision and fuel (limited to work- related travel only), and supplies.